DNP 805 Week 7 Case Report Health Care Informatics Assignment

DNP 805 Week 7 Case Report Health Care Informatics Assignment

DNP 805 Week 7 Case Report Health Care Informatics Assignment

DNP 805 Week 7 Case Report Health Care Informatics Assignment Details:

In this assignment, learners are required to write a case report addressing the personal knowledge and skills gained in the current course and potentially solving an identified practice problem.

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General Guidelines:

Use the following information to ensure successful completion of the assignment:

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

Doctoral learners are required to use APA style for their writing assignments. The APA Style Guide is located in the Student Success Center.
This assignment requires that at least two additional scholarly research sources related to this topic, and at least one in-text citation from each source be included.
You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.

DNP 805 Week 7 Case Report Health Care Informatics Assignment

Directions:

For a specific focus of patient practice (e.g., acute care hospital, clinic, primary care, long-term care, home health), select a particular disease process. Identify and fully describe the required technology elements that will be involved in providing care and define how these technologies will integrate treatment and/or monitoring from the identified care setting to the home and then to ongoing care.

Your case report must include the following:

Introduction with a problem statement

Brief literature review

Description of the case/situation/conditions

Discussion that includes a detailed explanation of the synthesized literature findings

Summary of the case

Proposed solutions

Conclusion

Portfolio Practice Hours:

It may be possible to earn Portfolio Practice hours for this case report. Enter the following after the references section of your paper:

SAMPLE SOLUTION APPROACH TO THE CASE REPORT

Case Report:  Health Care Informatics

Introduction

Central line associated blood stream infections (CLABSIs) continue to be a huge expense for health care organizations across the US as they cause harm to patients.  Some studies have estimated that the cost of a single CLASI episode can be as much as $25,000.  Therefore, a reduction in the use of central lines in hospitalized patients can help to reduce the number of days that patients have the catheters in place and also reduce the number of CLABSIs a patient may encounter (Pathak, Gangina, Jairam & Hinton, 2018).  Studies have shown that the use of care bundles that include the removal of catheters that are no longer needed is one of the most effective ways of preventing CLABSIs (Atkilla, Doganay, Celik, Tomak, Gunal, & Kilic, 2016).   However, when a central line is essential to the care of the patient, implementing measures to prevent CLABSIs is essential to prevent infections.  The problem is that in the inpatient setting, nurses forget to give patients with central lines chlorhexidine baths daily as indicated per hospital protocol or they forget to documentation.  They may also forget to do the documentation of the bath even when it has been completed and leaves nurse leaders with gaps in the medical record to understand what happened when CLABSIs do occur.  In this paper, the author will discuss the literature review that supports the use of chlorhexidine baths to prevent CLABSIs, discuss a case study of a patient who developed a CLABSI and describe the type of technology that is needed to help nurses take better care of patients who have a central line in place in order to prevent CLABSIs.

DNP 805 Week 7 Case Report Health Care Informatics Assignment

Applicable Care Based Technologies

Several care based technologies are possible solutions to help prevent CLABSI’s.  An electronic health record (EHR) can be used to provide clinical decision prompts to allow for timely care for patients (Alexander, S., Frith, K.H., & Hoy, 2019).  Computer physician order entry (CPOE) can prompt a reflex order that is generated to complete daily chlorhexidine baths whenever a physician documents or enters treatment with the insertion of a central line on a patient.  Additionally, the EHR can be designed to prompt nurses to provide chlorhexidine baths as a daily intervention that requires documentation to be completed.  Clinical decision support (CDS) can be implemented in the EHR to provide alerts and reminders for patient care, provide focused data reports and summaries and provide documentation templates to help with patient care compliance (Alexander, S., Frith, K.H., & Hoy, 2019).

Integration of Technologies and Treatment/Monitoring in Care Settings

The implementation of an EHR has many possibilities for leaders in different healthcare settings that include inpatient and outpatient settings, and doctor’s offices.  Records are easily accessed, data entry can be simplified, and multiple practitioners can access the records at the same time.  Care can be collaborated faster and easier with an EHR than with the old paper record system and the integration of decision support technology can quickly bring the most up to date evidence based practice to the practitioner at the point of care.  Treatment and follow up can happen quickly due to the ease and accessibility of (Alexander, S., Frith, K.H., & Hoy, 2019).  Therefore, with the implementation of technologies that are integrated in the EHR, a feasible solution can be found to help nurses to remember to complete chlorhexidine baths in the intensive care unit or for patients in an inpatient setting who have a central line in place.

Literature Review

In identifying a technological solution to the problem related to nurses not being compliant or consistent in giving chlorhexidine baths to prevent CLABSIs, a total of four articles were reviewed related to the use of chlorhexidine bed-baths to reduce central line associated blood stream infections (CLABSIs).   Sarani, Navidian, Jahani, Tabas & Bidar, (2017) completed a quasi-experimental study with 80 patients admitted to an ICU in a teaching hospital.  Patients in the inclusion group were bathed daily with chlorhexidine 2% solution. The patients in the control group did not get a daily bath with the chlorhexidine solution.  The study revealed that 100% of the control subjects had positive culture growth after 5 days of being in the ICU without having a chlorhexidine 2% bath and identified the effectiveness of the 2% chlorhexidine solution in preventing skin colonization and skin infections in ICU patients.  In a second study, Cleves, Pino, Patino, Rosso, Velez & Perez (2018) demonstrated a significant reduction in CLABSI rates in neonates with the use of chlorhexidine baths.  A reduction from 8.64 to 4.28 was seen CLABSIs per 1000 was observed in the unit.  A third study by Reagan et al., (2019), showed that an increase in chlorhexidine bathing compliance from 60% to 90% prevented 20 infections and saved almost one million dollars in costs for patient care.  As bathing compliance increased, the study showed that the overall costs of infections subsequently decreased.  Kim, Lee, Na, Roh, Shin & Kim (2016) completed a meta-analysis with eighteen studies that concluded that there was a greater reduction for CLASISs among critically ill patients with chlorhexidine bathing.  The study found that the risk for CLABIs is reduced when chlorhexidine baths are completed daily.

Description of Case

On day 1, Patient Clark (PC), a 67 year old female, was admitted to the cardiovascular intensive care unit (ICU) with an acute myocardial infarction.  On day 2, a central line was placed and she was taken to the cardiac catheterization lab.  On day 4, the central line was still in place.  PC became confused and she was having chills and her temperature was 38.4 degrees Celsius.  She went from a sinus rhythm on the cardiac monitor to a sinus tachycardia and her blood pressure dropped from 120 systolic to 92 systolic.  An infection was suspected and the physician ordered blood cultures to be drawn.  On day 5, the culture was resulted and identified enterococcus faecalis as the organism in the blood. Since the central line was in place for greater than 2 calendar days on the date of the fever and there was no other identified site of infection, PC was diagnosed with a central line associated bloodstream infection.   A review of the chart indicated that the nurses had not documented a chlorhexidine bath on days 2, 3 or 4 of her stay in the intensive care unit.  Although a daily chlorhexidine bath was a unit based protocol for infection prevention in the critical care unit, the nurses had not consistently ensured or documented that she had received the bath. The infection control nurse and nurse educator of the intensive care unit reviewed potential root causes of the CLABSI and identified the lack of completion of daily chlorhexidine baths as contributing to the CLABSI.

Synthesized Literature findings

The literature review identified the need for consistent daily baths with chlorhexidine to prevent the development of a CLABSI in patients who have a central line or for patients admitted to an intensive care unit (Sarani, Navidian, Jahani, Tabas & Bidar, 2017).  Additionally, Reagan et al. (2019) identified that an increase in chlorhexidine bathing compliance would reduce the number of infections and thus prevent CLABSIs.

Proposed Solution

The proposed solution is to include a tool in the electronic health record (EHR) that allows nurses a location to document the completion of a chlorhexidine bath.  The CPOE would include a reflex order for nurses to ensure the completion of a daily chlorhexidine bath whenever a physician enters a central line as an intervention or whenever the nurse documents the presence of a central line daily.  CDS would allow for data tracking that allows daily reports to be run and shared with nurse leaders to indicate compliance of documentation.  Nurse leaders would then be able to track and trend data and monitor for compliance with the chlorhexidine bathing protocol for the patient care area and share the information with stakeholders as indicated.  Additionally, the most important part of the solution is to implement an alert system in the EHR that notifies a nurse when a patient is 2 hours away from the 24-hour mark of their last chlorhexidine bath.  When the patient is at the 24-hour mark of their last chlorhexidine bath, there would be a second alert.  The purpose of the first alert is to allow the nurse time to evaluate the plan of care and facilitate having the patient receive a chlorhexidine bath within the remaining two-hour window.  The second alert is a reminder that would pop up only if the nurse had not yet documented the bath being completed after the first alert was triggered.  Therefore, this alert system would give the nurse two reminders to ensure compliance with the chlorhexidine bath is achieved. The alert system would close the technology gap and serve as a reminder for the nurse to provide timely evidence-based care. 

Conclusion

Care based technology has revolutionized the way care is being delivered to patients in multiple healthcare settings.  The use of EHRs, CPOE, CDS systems and data mining tools are all forms of technology that can provide feasible solutions to many identified patient care problems identified in healthcare.  The research has shown that the daily intervention of a chlorhexidine bath for critical care patients and those with a central line can help to reduce or prevent a central line associated blood stream infection.  Using the available technology, a system can be built that serves as a reminder for nurses to complete tasks such as giving chlorhexidine baths to patients in this population.

References

Alexander, S., Frith, K.H., & Hoy. (2019). Applied clinical informatics for nurses. Burlington, MA: Jones & Bartlett Learning.

Atilla, A., Doğanay, Z., Çelik, H. K., Tomak, L., Günal, Ö., & Kılıç, S. S. (2016). Central line-associated bloodstream infections in the intensive care unit: importance of the care bundle. Korean Journal of Anesthesiology, 69(6), 599–603.

https://doi-org.lopes.idm.oclc.org/10.4097/kjae.2016.69.6.599

Cleves, D., Pino, J., Patiño, J. A., Rosso, F., Vélez, J. D., & Pérez, P. (2018). Effect of

chlorhexidine baths on central-line-associated bloodstream infections in a neonatal intensive care unit in a developing country. Journal of Hospital Infection, 100(3), e196–e199. https://doi-org.lopes.idm.oclc.org/10.1016/j.jhin.2018.03.022

Kim, H. Y., Lee, W. K., Na, S., Roh, Y. H., Shin, C. S., & Kim, J. (2016). The effects of chlorhexidine gluconate bathing on health care–associated infection in intensive care units: A meta-analysis. Journal of Critical Care, 32, 126–137.

https://doi-org.lopes.idm.oclc.org/10.1016/j.jcrc.2015.11.011

Pathak, R., Gangina, S., Jairam, F., & Hinton, K. (2018). A vascular access and midlines program can decrease hospital-acquired central line-associated bloodstream infections and cost to a community-based hospital. Therapeutics and Clinical Risk Management, 1453. https://doi-org.lopes.idm.oclc.org/10.2147/TCRM.S171748

Reagan, K. A., Chan, D. M., Vanhoozer, G., Stevens, M. P., Doll, M., Godbout, E. J., Cooper, K., Pryor, R. J., Hemphill, R. R., & Bearman, G. (2019). You get back what you give: Decreased hospital infections with improvement in CHG bathing, a mathematical modeling and cost analysis. American Journal of Infection Control, 47(12), 1471.

Sarani, H., Navidian, A., Jahani, S., Tabas, E. E., & Bidar, S. (2017). Evaluation of the Daily Chlorhexidine Bath Effect on Skin Colonization of the Intensive Care Unit Patients. Medical-Surgical Nursing Journal, 5(4), 38–44.

I, (John Doe), verify that I have completed (10) clock hours in association with the goals and objectives for this assignment. I have also tracked said practice immersion hours in the Typhon Student Tracking System for verification purposes and will be sure that all approvals are in place from my faculty and practice mentor.

DNP 805 Week 8 Assignment Evaluation of Health Care Technology

Details

For this assignment, you will utilize content from the course materials as well as additional qualified resources to synthesize new information which you can apply towards your DPI Project, your future work area or your clinical practice as a DNP-prepared nurse.

General Guidelines:

Use the following information to ensure successful completion of the assignment:

  • This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
  • Doctoral learners are required to use APA style for their writing assignments. The APA Style Guide is located in the Student Success Center.
  • This assignment requires that at least two additional scholarly research sources related to this topic, and at least one in-text citation from each source be included.
  • You are required to submit this assignment to Turnitin. Refer to the directions in the Student Success Center.

Directions:

For this assignment, write a 1,000-1,250 word paper in which you:

  1. Select a technology that has been explored in the course.
  2. Perform an assessment using elements of user-technology interface or human factors methods to determine functionality.
  3. Using the content in the readings and textbook, list three elements that will be used to evaluate the user-technology interface.
  4. Select a technology and list the elements that will be evaluated. Include their definition and describe how the element would be measured or evaluated.
  5. For each element, propose practicable suggestions for improvement using support from the literature.

Portfolio Practice Hours

It may be possible to earn Portfolio Practice hours for this case report. Enter the following after the references section of your paper:

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DNP 805 Week 8 Assignment Reflective Journal

Details:

Learners are required to maintain a reflective journal integrating leadership and inquiry into current practice.

In your journal, reflect on the personal knowledge and skills gained in the this course and address a variable combination of the following: new practice approaches, intraprofessional collaboration, health care delivery and clinical systems, ethical considerations in health care, population health concerns, the role of technology in improving health care outcomes, health policy, leadership and economic models, and/or health disparities. Outline what you have discovered about your professional practice, personal strengths and weaknesses that surfaced, what additional resources and abilities could be introduced to a given situation to influence optimal outcomes, and finally how you met the competencies aligned to this course.

You are not required to submit this assignment to Turnitin.

Submit your reflective journal both to the instructor and in the Typhon Tracking System under the corresponding course section. Failure to submit your journal in both the course room and Typhon systems may result in a grade of Incomplete for the course. Course Tutor Source

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